Customary practices, domestic violence, and psychosomatic pain among adolescent mothers in Turkey.

BACKGROUND: Adolescent motherhood is present in many societies worldwide, including Turkey. AIMS: We aimed to determine the demographical and cultural characteristics of adolescent mothers, lifetime domestic violence and history of miscarriage, and whether they suffer from any kind of medically unexplained (psychosomatic) pain in a study in south-eastern Turkey. METHODS: We included 501 mothers in this case-control study. The study group comprised 228 mothers who gave their first deliveries at or before 19 years of age, and the control group consisted of 273 mothers who first delivered after 19 years of age. The case-control study was conducted between February and April 2013 in Diyarbakir, Turkey. RESULTS: Adolescent mothers marry more frequently with their relatives. They have a higher prevalence of culture-bound customary applications such as bride price. They are less likely to be asked for their consent to marry and tend to have more children. They are more frequently victims of domestic violence and more often report medically unexplained psychosomatic pain. CONCLUSIONS: Adolescent motherhood is still a public health problem that seems to be related to certain culture-bound customary practices, continuing domestic violence across generations, increased number of children, and more prevalent psychosomatic pain.

Evaluation of the protective effects of CoQ10 on ovarian I/R injury: an experimental study.

BACKGROUND: The aim of this study was to investigate the protective effects of coenzyme Q10 (CoQ10) on ovarian ischemia/reperfusion injury in an experimental rat adnexal torsion model. METHODS: 48 female adult Wistar albino rats, weighing 220-250 g, were randomly equally divided into six groups (n = 8): sham, torsion, detorsion, sham+CoQ10, torsion+CoQ10, and detorsion+CoQ10 groups. Bilateral adnexal torsion was performed for 3 h in all groups, except the sham and sham+CoQ10 groups. Bilateral adnexal detorsion was performed on the detorsion and detorsion+CoQ10 groups. CoQ10 was injected intraperitoneally 30 min before the sham operation, torsion, and detorsion. RESULTS: The torsion and detorsion groups had significantly higher histologic evaluation scores, as well as higher MDA levels, TOS values, and oxidative stress index values than the sham group. A strong correlation between total histologic evaluation scores for ischemia/reperfusion injury and the oxidative stress index was found. The mean oxidant marker levels and histopathologic scores for the ovarian tissue significantly decreased after using CoQ10, which is a potent antioxidant. CONCLUSIONS: Conservative surgery (detorsion) was found to provide inadequate protection to ovarian tissue. The results of this study suggest that CoQ10 could be useful for the protection of ovarian tissue before conservative surgery.

Misoprostol-induced termination of second-trimester pregnancy in women with a history of cesarean section: a retrospective analysis of 56 cases.

OBJECTIVE: To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. MATERIALS AND METHODS: Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. RESULTS: There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p = 0.05) and additional procedure for abortion (p = 0.056) were found to be similar in both groups. However laparotomy (p = 0.004), uterine rupture (p = 0.016), hysterotomy (p < 0.001) were performed more frequently in the study group; while abortion was more likely to occur within 24 hours in the control group (p = 0.031). CONCLUSION: Medical abortion must be carefully used for the termination of second trimester pregnancies in women with a history of CS. Increased possibility of uterine rupture and requirement of interventions such as laparotomy or hysterotomy is more likely in these patients.

Uterine rupture revisited: Predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey.

OBJECTIVE: To determine the predisposing factors, modes of clinical presentation, management modalities and fetomaternal outcomes of uterine rupture cases at a tertiary care center in Turkey. METHODOLOGY: A 14-year retrospective analysis of 61 gravid (>20 weeks of gestation) uterine rupture cases between January 1998 to March 2012 was carried out. RESULTS: The incidence of ruptured uteri was calculated to be 0.116%. Persistence for vaginal delivery after cesarean was the most common cause of uterine rupture (31.1%). Ablatio placenta was the most common co-existent obstetric pathology (4.9%). Bleeding was the main symptom at presentation (44.3%) and complete type of uterine rupture (93.4%) was more likely to occur. Isthmus was the most vulnerable part of uterus (39.3%) for rupture. The longer the interval between rupture and surgical intervention, the longer the duration of hospitalization was. Older patients with increased number of previous pregnancies were likely to have longer hospitalization periods. CONCLUSION: Rupture of gravid uterus brings about potentially hazardous risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center may reduce the incidence of this condition.

Immunoexpression of vascular endothelial growth factor and B-cell lymphoma 2 in the uterine tissue of rats treated with melatonin in the estrus phase1.

PURPOSE: To investigate the effect of melatonin on uterine tissue in the ovariectomized rat model. METHODS: Fourty Wistar albino rats were divided into four groups for histologic and immunohistochemical examination. The rats were first numbered randomly and then randomly divided into 4 equal groups: control (group 1), torsion (group 2), torsion+detorsion (group 3) and torsion+detorsion+melatonin (group 4) groups. In addition, four Wistar albino rats were used for western blot analysis in each group. And also, malondialdehyde (MDA) levels were measured biochemically in all rats. RESULTS: The histopathological examination of the uterine tissue in rats ovarectomized showed a degeneration in uterine glands, dilation of blood vessels in the internal layer with a thrombosis and bleeding, abnormal nucleuses and vacuolated cytoplasm above and below the nucleus. In torsion group, the apoptotic cells increased in luminal epithelium and gland cells. In the melatonin group showed that the Bcl2 negative effect on the uterine epithelium and did not lead to apoptotic cells. CONCLUSION: The increase in vascular endothelial growth factor expression resulted in the rearrangement of endothelial cell growth and the induction of angiogenesis.

Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?

OBJECTIVE: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. METHODS: MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. RESULTS: The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture. CONCLUSIONS: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Role of inflammation and oxidative stress in the etiology of primary ovarian insufficiency.

OBJECTIVE: The aim of this study was to elucidate the etiology and treatment of primary ovarian insufficiency, which is of unknown cause in 95% of the cases. MATERIALS AND METHODS: Thirty patients aged 18-40 years who presented to Dicle University Faculty of Medicine Clinic of Obstetrics and Gynecology between June 2012 and January 2014 and were diagnosed as having primary ovarian insufficiency based on their clinical and endocrinologic data, and 30 healthy controls were included in this study. RESULTS: No significant differences were found between patients with primary ovarian insufficiency and control subjects in demographic data and lipid profile levels, thyroid- stimulating hormone, prolactin, and glucose. However, the neutrophil to lymphocyte ratio and levels of follicle-stimulating hormone, luteinizing hormone, total antioxidant status, total oxidant status, and oxidative stress index were significantly higher in patients with primary ovarian insufficiency than in control subjects. In the correlation analysis, follicle-stimulating hormone exhibited a positive correlation with total oxidant status, oxidative stress index, and the neutrophil to lymphocyte ratio (r=0.573** p<0.001, r=0.584** p<0.001, r=0.541 p<0.001, respectively) and correlated negatively with total antioxidant status (r=-0.437** p<0.001). CONCLUSION: The neutrophil to lymphocyte ratio, total oxidant status, and oxidative stress index levels are elevated in primary ovarian insufficiency. Therefore, anti-oxidative and anti-inflammatory treatment might be administered to patients in the early stage of primary ovarian insufficiency. However, larger studies are needed to clarify whether these elevated levels are a cause or a consequence of primary ovarian insufficiency.

Protective effects of honokiol on ischemia/reperfusion injury of rat ovary: an experimental study.

AIM: The purpose of this study was to investigate the protective effect of honokiol on experimental ischemia/reperfusion injury of rat ovary. MATERIALS AND METHODS: A total of 40 female Wistar albino rats were used in this study. The rats were divided into five groups as follows: sham (Group I), torsion (Group II), torsion + detorsion (Group III), torsion + detorsion + saline (Group IV), and torsion + detorsion + honokiol (Group V). Bilateral adnexa in all the rats except for those in the sham group were exposed to torsion for 3 hours. The rats in Group IV were administered saline, whereas the rats in Group V were administered honokiol by intraperitoneal route 30 minutes before detorsion. Tissue and plasma concentrations of malondialdehyde and nitric oxide were determined. Ovarian tissue was histologically evaluated. Data analyses were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (Bonferroni correction) in SPSS 15.0 (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL, USA). RESULTS: The torsion and detorsion groups had higher scores in vascular congestion, hemorrhage, and inflammatory cell infiltration compared with the sham group (P<0.005). In addition, total histopathological scores were significantly higher in the torsion and detorsion groups compared with the sham group (P<0.005). A significant reduction was observed in hemorrhage, inflammatory cell infiltration, and cellular degeneration scores, of all histopathological scores, in the honokiol group (P<0.005). Ovarian tissue concentrations of malondialdehyde were significantly higher in the torsion and detorsion groups compared with the sham and honokiol groups (P<0.005). Ovarian tissue concentrations of nitric oxide, on the other hand, were significantly higher in the torsion group compared with the sham, saline, and honokiol groups (P<0.005). CONCLUSION: Honokiol has a beneficial effect on ovarian torsion-related ischemia/reperfusion injury.

Single intrauterine demise in twin pregnancies: Analysis of 29 cases.

OBJECTIVE: To evaluate the maternal and fetal demographic features and clinical aspects of twin pregnancies with single intrauterine demise. MATERIALS AND METHODS: This retrospective study was conducted in Dicle University Faculty of Medicine, Department of Gynecology and Obstetrics between January 2008 and December 2013. There were a total of 594 twin deliveries in our hospital between the given dates. Twenty-nine of these cases were referred to our hospital by another health center because of a preliminary diagnosis of single intrauterine demise. Maternal age, parity, chorionicity, week of fetal death, gestational week at delivery, mode of delivery, birth weight, Activity, pulse, grimace, appearance, respiration scores, maternal fibrinogen levels at delivery and during pregnancy, stay in the neonatal intensive care unit, and obstetric complications were explored in these 29 cases of single intrauterine demise. RESULTS: The mean age of the 29 patients who were provided antenatal follow-up and delivery services in our hospital was 29.9±6.5 years. Thirteen (44.8%) of the patients were monochorionic, whereas 16 (55.2%) were dichorionic. Intrauterine fetal death occurred in the first trimester in 6 pateints and in the second or third trimester in 23. In addition, 20 (69%) patients underwent cesarean section, whereas 9 (31%) had spontaneous vaginal delivery. Lastly, none of the patients had a maternal coagulation disorder. CONCLUSION: Twin pregnancies with single intrauterine death can lead to various complications for both the surviving fetus and the mother. Close maternal and fetal monitoring, and proper care and management can minimize complications.

Effects of Potentilla fulgens as a Prophylactic Agent for Ischemia/Reperfusion Injury in the Rat Ovary.

OBJECTIVE: To investigate the effects of Potentilla fulgens as a prophylactic agent on ischemia/reperfusion (I/R) injury in the rat ovary. STUDY DESIGN: A total of 32 Wistar rats were divided into 4 equal groups: (I) sham, (II) ischemia, (III) ischemia + reperfusion, and (IV) IR + Potentilla fulgens. In groups I and II, ovary torsion was not performed and no drug was administered. In group III, 1 hour of ischemia and 2 hours of reperfusion were performed and no drug was given. Group IV received 400 mg/kg/day Potentilla fulgens intraperitoneally 5 days before I/R injury. RESULTS: The detorsion group showed preantral ovarian follicles and corpus luteum around the blood vessels and positive expression of vascular endothelial growth factor (VEGF). In the Potentilla fulgens group (IV) the stromal vascular endothelium with weak expression of VEGF was detected in small areas, and the ovarian follicles and the corpus luteum showed negative expression of VEGF. In the detorsion group the theca cells and apoptotic cells in preantral follicles showed positive expression of E-cadherin in the ovarian surface epithelium. Moreover, the E-cadherin expression was found to be positive in terms of follicular development, theca cells, granulosa cells, and corpus luteum. Potentilla fulgens, given after ischemic injury and apoptosis, was seen to decrease the effect of Bcl-2 expression. CONCLUSION: These results provide compelling evidence that the expression of E-cadherin in the ovary is an important component of ovarian function.

Immunoexpression of vascular endothelial growth factor and B-cell lymphoma 2 in the uterine tissue of rats treated with melatonin in the estrus phase

Abstract Purpose: To investigate the effect of melatonin on uterine tissue in the ovariectomized rat model. Methods: Fourty Wistar albino rats were divided into four groups for histologic and immunohistochemical examination. The rats were first numbered randomly and then randomly divided into 4 equal groups: control (group 1), torsion (group 2), torsion+detorsion (group 3) and torsion+detorsion+melatonin (group 4) groups. In addition, four Wistar albino rats were used for western blot analysis in each group. And also, malondialdehyde (MDA) levels were measured biochemically in all rats. Results: The histopathological examination of the uterine tissue in rats ovarectomized showed a degeneration in uterine glands, dilation of blood vessels in the internal layer with a thrombosis and bleeding, abnormal nucleuses and vacuolated cytoplasm above and below the nucleus. In torsion group, the apoptotic cells increased in luminal epithelium and gland cells. In the melatonin group showed that the Bcl2 negative effect on the uterine epithelium and did not lead to apoptotic cells. Conclusion: The increase in vascular endothelial growth factor expression resulted in the rearrangement of endothelial cell growth and the induction of angiogenesis.

Venous intravasation as a complication and potential pitfall during hysterosalpingography: re-emerging study with a novel classification.

OBJECTIVES: Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation. MATERIALS AND METHODS: This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software. RESULTS: Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation. CONCLUSIONS: Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.